Femoral Deformities: Varus, Valgus, Retroversion, and Anteversion

Abstract

Osteoarthritis of the hip is almost always due to a structural abnormality. These abnormalities may include any of the following, often in bewildering combinations: acetabular dysplasia, femoroacetabular impingement (FAI), coxa valga, coxa vara, and retroversion or excessive anteversion of the femur or acetabulum. Femoral osteotomy is a powerful tool to correct these deformities. The most commonly employed types are varus or valgus intertrochanteric, with or without derotation. Extension or flexion of the intertrochanteric osteotomy may be added if it is desirous to change the head position in the sagittal plane. Pure derotation osteotomies may be performed alone if abnormal version is the sole deformity. Historically, femoral osteotomies were employed in a “salvage” mode for pain relief. Since the advent of total hip arthroplasty, femoral osteotomy is now best suited to a “hip preservation” mode. It is important to determine which of these abnormalities may be present, with the realization that it may require additional radiographic studies, such as CT scans, to make the correct diagnosis. This is especially important with version abnormalities, which can be very difficult to diagnose on plain radiographs. A thorough physical examination is critical to assess range of motion, leg length, and the foot progression angle, since these may all be altered with a corrective osteotomy. It is important to remember that correcting one deformity (such as excessive femoral anteversion) may exacerbate another, such as FAI. When correctly executed, femoral osteotomy can provide long-term pain relief and functional improvement. The procedure may also obviate the necessity of total hip arthroplasty, especially if performed before the onset of significant articular cartilage damage.